Exemplar- Multiple Sclerosis
A nurse is caring for a client who has a history of severe multiple sclerosis and asks the nurse about completing a living will. Which of the following statements should the nurse make? A."I will provide you with the information you need to complete advance directives." B."I will contact your provider to inform him of your desire to complete a living will." C."Your attorney will need to review the document before it can be enacted." D."Once your living will is complete and on file, the choices you make are final."
Correct Answer: A. "I will provide you with the information you need to complete advance directives." Under the Patient Self-Determination Act, health care institutions are required to provide educational materials advising clients of their rights to make personal wishes known regarding treatment. Incorrect Answers: B. The nurse does not need to contact the provider unless the client has questions for the provider concerning treatment options. The nurse will contact the provider and document in the medical record once the client has completed a living will. C. This document does not require the review of an attorney. D. The nurse should inform the client that even if a living will is completed, the decision can always be changed.
A nurse is caring for a client who has multiple sclerosis and is receiving interferon beta-1a. The nurse should identify that which of the following client statements indicates a potential adverse effect of the medication? A."My body aches all over." B."I have abdominal cramping." C."My hair seems to be thinning." D."It hurts when I urinate."
Correct Answer: A. "My body aches all over." The adverse effects of interferon beta-1a can include flu-like symptoms such as general body and muscle aches. Incorrect Answers:B. Dimethyl fumarate can cause gastrointestinal discomfort, including abdominal cramping. C. Teriflunomide, a disease-modifying medication, can cause alopecia. D. Natalizumab, a disease-modifying medication, can cause urinary tract infections that manifest as dysuria.
A nurse is providing teaching to a client who has a new diagnosis of multiple sclerosis (MS). The client asks the nurse about the usual cause of MS. Which of the following responses should the nurse make? A."Each client is different; we cannot predict what will happen." B."I can see that you are worried, but it's too soon to predict what will happen." C."Acute episodes are usually followed by remissions, which can vary in duration." D."It's too early to think about the future; let's focus on the present and take each day as it comes."
Correct Answer: C. "Acute episodes are usually followed by remissions, which can vary in duration." This client is asking an information-seeking question, so the nurse should provide the client with factual information. The nurse should inform the client that MS is a chronic autoimmune disorder characterized by remissions and exacerbations, with exacerbations becoming more frequent and intense as the disease progresses. Incorrect Answers:A. This answer does not provide information to the client and blocks further communication. B. In this response, the nurse acknowledges the client's feelings but then blocks communication by not providing any information to help address the client's fears. D. In this response, the nurse is giving advice, which can block communication by discouraging the client from expressing concerns and fears.
A nurse is caring for a client with multiple sclerosis and neurogenic bladder who is receiving bethanechol. The nurse should identify that which of the following client statements indicates a therapeutic action of the medication? A."My mouth seems very dry lately." B."I've noticed my heart beating faster." C."I am able to urinate more freely." D."I've noticed I can take a deep breath more easily."
Correct Answer: C. "I am able to urinate more freely." The nurse should identify that bethanechol is administered for the treatment of urinary retention. A therapeutic effect is indicated by the client stating that urination occurs more freely. Incorrect Answers:A. Bethanechol, a muscarinic agonist, can cause excessive salivation. B. Due to its vasodilating effects, bethanechol can cause hypotension and bradycardia. D. Bethanechol activates muscarinic receptors in the lungs, causing bronchoconstriction; it would not make breathing easier for the client
A nurse is reviewing the medical history of a client who has spasticity due to multiple sclerosis and a new prescription for tizanidine. Which of the following comorbidities increases the client's risk of adverse effects while taking this medication? A.Pneumonia B.Benign prostatic hypertrophy (BPH) C.Hepatitis D.Diabetes mellitus
Correct Answer: C. Hepatitis Tizanidine can cause liver damage. This medication should be used with extreme caution in a client who has a preexisting impairment of hepatic function. Incorrect Answers:A. Tizanidine can cause urinary rhinitis; however, a history of pneumonia does not increase the client's risk of developing adverse effects while taking tizanidine. B. Baclofen might cause urinary retention, which should be considered in male clients who have BPH. However, BPH does not increase the client's risk of developing adverse effects while taking tizanidine. D. Clients who have diabetes mellitus do not have an increased risk of developing adverse effects while taking tizanidine.
A nurse is teaching about the adverse effects of baclofen with a client who has multiple sclerosis with spasms. Which of the following statements should the nurse identify as an indication that the client understands the teaching? A."Adverse effects include urinary frequency." B."I should increase my fiber intake to counteract the adverse effect of diarrhea." C."This medication can cause addiction." D."I should not stop taking this medication suddenly."
Correct Answer: D. "I should not stop taking this medication suddenly." The nurse should inform the client about the adverse effects associated with abrupt withdrawal of baclofen such as visual hallucinations, paranoid ideations, and seizures. Incorrect Answers:A. The nurse should inform the client that baclofen is a muscle relaxer that can cause urinary retention. B. The nurse should inform the client that adverse effects of baclofen can involve the central nervous system and gastrointestinal tract. However, baclofen is more likely to cause constipation than diarrhea. C. The nurse should inform the client that baclofen is not associated with physical dependence.
A nurse is providing teaching to a client who has multiple sclerosis and a new prescription for baclofen PO. Which of the following pieces of information should the nurse include? A."You should take the medication on an empty stomach to increase absorption." B."You can stop taking the medication once your back spasms disappear." C."You can expect to experience urinary frequency when you first start taking this medication." D."You should change positions slowly while taking this medication."
Correct Answer: D. "You should change positions slowly while taking this medication." The nurse should teach the client that dizziness and hypotension are adverse effects of this medication. The client should change positions slowly to minimize orthostatic hypotension. Incorrect Answers:A. The nurse should teach the client to take baclofen with milk or food to minimize gastric irritation. B. The nurse should teach the client that stopping the medication abruptly can cause an acute withdrawal reaction, including manifestations such as hallucinations and increased spasticity. The medication should be discontinued gradually over at least 2 weeks. C. The nurse should teach the client that urinary frequency is an adverse effect of baclofen. The client should notify the provider if this manifestation occurs.
A nurse is teaching a client who received a prescription for interferon beta-1a for the treatment of multiple sclerosis. Which of the following information should the nurse include? A. Have kidney function tests done every month for a year B. Take an extra dose if muscle aches occur C. Store the drug at room temperature after mixing it D. Administer the drug in your thigh or upper arm
D. Administer the drug in your thigh or upper arm
A nurse is caring for a client who is taking interferon beta-1b. The nurse should identify that which of the following finding indicated a potential serious adverse effect of this drug? A. Tinnitus B. Twitching eyelids C. Blue-green Skin discoloration D. Fatigue
D. Fatigue
A nurse is teaching a client who has a prescription for baclofen. Which of the following instructions should the nurse include? A. Avoid driving until the drug's effects are evident. B. Stop taking the drug immediately if headache occurs. C. Take the drug as needed for spasticity. D. Take the drug with antacids to reduce gastric effects.
A. Avoid driving until the drug's effects are evident.
A nurse is providing teaching for a client who has multiple sclerosis and a new prescription for methylprednisolone. Which of the following instructions should the nurse include? (Select all that apply) A. Blood glucose levels will need to be monitored during therapy. B. Avoid contact with persons who have known infections. C. Take the medication 1 hour before a meal. D. Decrease intake of foods containing potassium. E. Grapefruit juice can increase the blood levels of the medication.
A. Blood glucose levels will need to be monitored during therapy. B. Avoid contact with persons who have known infections. E. Grapefruit juice can increase the blood levels of the medication.
A nurse is beginning a physical assessment of a client who has a new diagnosis of multiple sclerosis. Which of the following findings should the nurse expect? (Select all that apply.) A. Areas of paresthesia B. Involuntary eye movements C. Alopecia D. Increased salivation E. Ataxia
A. CORRECT: Areas of loss of skin sensation are a finding in a client who has MS. B. CORRECT: Nystagmus is a finding in a client who has MS. C. Hair loss is not a finding in a client who has MS. D. Dysphagia, swallowing difficulty, is a finding in a client who has MS. E. CORRECT: Ataxia occurs in the client who has MS as muscle weakness develops and there is loss of coordination.
A nurse is caring for a client who has multiple sclerosis. Which of the following findings should the nurse expect? A. Fluctuations in blood pressure B. Loss of cognitive function C. Ineffective cough D. Drooping eye lids
A. Fluctuations in blood pressure is a manifestation associated with amyotrophic lateral sclerosis. B. CORRECT: Loss of cognitive function is a manifestation associated with MS. C. Ineffective cough is a manifestation associated with amyotrophic lateral sclerosis. D. Drooping eyelids is a manifestation associated with myasthenia gravis.
A nurse is teaching a client about interferon beta-1a. Which of the following instructions should the nurse give to help the client avoid the adverse effects of this drug? A. Premedicate with acetaminophen B. Take the drug with food C. Increase your fluid intake D. Take the drug in the morning.
A. Premedicate with acetaminophen
A nurse is teaching a client who has multiple sclerosis and a new prescription for baclofen. Which of the following statements should the nurse include in the teaching? A. "This medication will help you with your tremors." B. "This medication will help you with your bladder function." C."This medication may cause your skin to bruise easily." D."This medication may cause your skin to appear yellow in color."
A. Primidone and clonazepam are beta blockers given to clients who have MS to treat tremors. B. Propantheline is an anticholinergic medication that is given to clients who have MS to treat bladder dysfunction. C. Prednisone is a corticosteroid medication that is given to clients who have MS to treat inflammation. An adverse effect of this medication is bruising of the skin. D. CORRECT: Dantrolene and tizanidine are antispasmodic medications that are given to clients who have MS to treat muscle spasms. An adverse effect of this medication is a yellow appearance of the skin, also known as jaundice. The nurse should instruct the client to monitor for this finding, as this can be an indication of impaired liver function.
A nurse is teaching a client who has multiple sclerosis and has a new prescription for glatiramer acetate. Which of the following statements indicates that the client understands the teaching? A. "I will ask my partner to give the injection in the same spot each time" B. "I will avoid going to the store when it is crowded" C. "I will see relief of my symptoms in about 1 wk" D. " I will exercise rigorously while taking this medication"
B. "I will avoid going to the store when it is crowded"
